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Pitfalls of Diagnosing Left Lower Quadrant Pain Causes: Making the Uncommon Common Again

Christian Saliba, Samer H. Diab, Gregory Nicolas, Julien S. El Sayegh, Dani Osman, Jean Michel Azzo, Ali Dabbous, Hussein Hmadeh, Ali Wehbe, Houssein Haidar Ahmad

(Department of Surgery, Beirut General Hospital, Beirut, Lebanon)

Am J Case Rep 2019; 20:78-82

DOI: 10.12659/AJCR.912226


BACKGROUND: Left-sided acute appendicitis, although well described in the literature, is still an easily missed diagnosis. Midgut malrotation and situs inversus are 2 known leading conditions that contribute to misdiagnosis of appendicitis.
CASE REPORT: Here is the case of a 27-year-old male without any previous medical history, who presented with left lower quadrant tenderness and was misdiagnosed with gastroenteritis as an outpatient and sent home; the patient presented the next day to the emergency department where he was found to have acute appendicitis with situs inversus. He underwent laparoscopic appendectomy where a phlegmon was identified. Pathology came back as peri-appendiceal mucocele with no signs of malignancy.
CONCLUSIONS: This case report aimed to revisit the idea of left-sided acute appendicitis and discuss the management of a perforated appendiceal mucocele contained by a phlegmon.

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